Introduction to

Gastrointestinal Radiology

Piyaporn Apisarnthanarak, M.D.

Faculty of Medicine Siriraj Hospital
 GI Radiology

• Plain Film
• Fluoroscopy (barium studies)
• Ultrasound (US)
• Computed Tomographic (CT) scan
• Magnetic Resonance Imaging
(MRI)
 Plain Film
• Pro:
– Cheapest and more available
– Good for screening of
• Abnormal air
• Abnormal calcification
• Abnormal bowel gas dilatation

• Cons:
– Radiation
– DDx only 5 density: air, fat, soft tissue, bone,
and metallic
Density in Plain Films
3
4

2
3 1
1 = air

4
2 = fat
3 = soft tissue
5
4 = bone
5 = metallic
 Plain Film
• Plain abdomen
– Supine
– Upright

• Acute abdominal series

– Abdomen: supine, upright
– CXR: upright
 Plain Abdomen

Supine Upright
 Plain Film
• Plain abdomen
– Supine
– Upright

• Acute abdominal series

– Abdomen: supine, upright
– CXR: upright
 Plain Abdomen

• Abnormal air
– Pneumoperitoneum
• Abnormal bowel gas dilatation
– Gut obstruction
– Paralytic ileus
• Abnormal calcification
– Gallstone
 Abnormal Air:
Pneumoperitoneum

• Perforation of hollow viscus

• Signs in plain films

– Free air beneath diaphragm (upright)
Pneumoperitoneum

CXR: upright
Abnormal Bowel Gas Dilatation

• Gut obstruction
• Paralytic ileus
Gut Obstruction vs Ileus

• Proportion of prox. and distal bowels

• Upright view: air- fluid level
• Bowel sound
• Follow up film
 Gut Obstruction

supine upright
 Paralytic Ileus

supine upright
Abnormal Calcification:
Gallstones

AP Lateral
 Fluoroscopy
• Pro:
– See mucosal / intraluminal lesion
– Real time
– Dynamic study [anatomy and movement
(peristalsis)]

• Cons:
– Radiation
– Contrast use: barium sulfate (single vs double
contrast)
Single vs Double Contrast
Mucosal Details

Stomach

Small bowels

Colon
 Fluoroscopy

• Normally use barium sulfate

• Use water soluble contrast when suspect
of leakage (prevent granulomatous infection)
 Fluoroscopy

– Esophagography
– Upper GI series (UGIS)
– GI follow through (GIFT)
– Barium Enema
 Esophagography

– Terminate at EG junction
• Except see lesion in gastric fundus
 Esophagography

EG
junction
Spot Films
 Esophagography

Overhead
Films
 UGIS or GISM

• Evaluate stomach and duodenum

• Terminate at DJ junction
• NPO at least 6 hours
• Prefer double contrast technique: for mucosal
fold details
• In case of gastric outlet obstruction: lavage
before study
Anatomy of Stomach
 Anatomy of Duodenum
• 4 parts
– 1st part or duodenal bulb (cap)
• Triangular shape
• Intraperitoneal: free movement
• Smooth mucosa
– 2nd, 3rd and 4th part duodenum
• C-loop or duodenal loop: encircle pancreatic
head
• Retroperitoneal structures: fixed
• Mucosa: feathery appearance
UGIS: Spot Views
UGIS: Overhead Films
 GI Follow Through

• NPO at least 6 hrs

• Terminate when barium reach colon
• Indication: suspected small bowel lesions
 GI Follow Through

• Folds: feathery appearance

– jejunum > ileum
• Jejunum: LUQ, ileum: RLQ
GI Follow Through
GI Follow Through
 Barium Enema

• Evaluate colonic pathology

• Preparations
– Laxatives the night before BE
– Soft and liquid diet at least 2 days
– Warm water enema before study
• Terminate when
– Barium reach cecum
– Filled appendix
– Reflux to terminal ileum
Colonic Anatomy
Barium Enema: Overhead
Barium Enema: Spot